Nicole Larson

Neighborhood environments: disparities in access to healthy foods in the U.S.

BACKGROUND Poor dietary patterns and obesity, established risk factors for chronic disease, have been linked to neighborhood deprivation, neighborhood minority composition, and low area population density. Neighborhood differences in access to food may have an important influence on these relationships and health disparities in the U.S. This article reviews research relating to the presence, nature, and implications of neighborhood differences in access to food. METHODS A snowball strategy was used to identify relevant research studies (n=54) completed in the U.S. and published between 1985 and April 2008. RESULTS Research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower levels of obesity. Results from studies examining the accessibility of restaurants are less consistent, but there is some evidence to suggest that residents with limited access to fast-food restaurants have healthier diets and lower levels of obesity. National and local studies across the U.S. suggest that residents of low-income, minority, and rural neighborhoods are most often affected by poor access to supermarkets and healthful food. In contrast, the availability of fast-food restaurants and energy-dense foods has been found to be greater in lower-income and minority neighborhoods. CONCLUSIONS Neighborhood disparities in access to food are of great concern because of their potential to influence dietary intake and obesity. Additional research is needed to address various limitations of current studies, identify effective policy actions, and evaluate intervention strategies designed to promote more equitable access to healthy foods.

Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change.

Emerging adulthood: a unique developmental stage Over the past 50 years, major population-level demographic shifts including increases in postsecondary education and delays in marriage and childbearing have occurred. These shifts have opened the door for a period of “emerging adulthood,” typically defined as 18–25 years of age (1). This period is marked by important transitions such as leaving home and increasing autonomy in decision-making; however at the same time, adult responsibilities such as financial independence and residential and employment stability are still in flux. This period of emerging adulthood may be an important, yet overlooked, age for establishing long-term health behavior patterns. Several factors differentiate emerging adulthood from other life stages and have specific relevance to the formation of health behavior patterns, including identity development and shifting interpersonal influences. One defining characteristic of this life stage is the development of a self identity. Emerging adulthood is a time for the exploration of new ideologies and behaviors which allow individuals to express their individuality. Given previous research showing that identity (e.g., incorporating healthy lifestyle characteristics in the concept of one’s self) is an important indicator of lasting health behavior change, emerging adulthood may be a particularly important time for establishing and intervening on long-term health behavior patterns (2,3). In addition, other psychosocial attributes associated with beneficial health behaviors (e.g., self-efficacy) develop or become established during this period of emerging adulthood (4), providing support for the unique importance of this life stage in long-term behavioral patterning. Emerging adulthood may also be a time for changing support systems and shifting interpersonal influences. Although the influence of parents and family is well established in the literature on childhood and, to a lesser extent, adolescent diet and physical activity patterns, little research has examined these issues among young adults. Young adults spend more leisure time alone compared to other age group (except retirees ≥55 years) (5) and are often assumed to be more disconnected from their family. However, some research suggests that closer relationships with parents (6,7) and siblings (8) may evolve as youth transition into college and adulthood (9,10). As youth become more independent, family and social network influences begin to shift and may serve different roles, as compared to that which they served in childhood and adolescence. Much additional research is needed to understand the evolving social influences in the emerging adult years and the extent to which this may influence health behavior patterns. Given the overall paucity of research in this area, more work is needed to understand better how the unique characteristics of emerging adulthood may contribute to establishing long-term behavioral patterns and the possible vulnerability of this life stage to various influences. Obesity is a major public health concern, and effective population-wide intervention strategies aimed at reducing obesity are needed. Although a growing body of literature has explored modifiable determinants of excess weight gain in adults and, to a lesser extent, in children, other important ages have been understudied. Though once considered to be an age of optimal health and well-being, the transition from adolescence to young adulthood is gaining recognition as an important time for health promotion and disease prevention. Not only is the presence of obesity and unhealthy lifestyle characteristics at this life stage associated with increased chronic disease risk, but this also may be a critical time during which young people establish independence and adopt lasting health behavior patterns. The objectives of this article are to: (i) describe emerging adulthood as a developmentally unique life stage, (ii) highlight epidemiologic evidence documenting adverse changes in diet, physical activity, and weight during this stage, (iii) discuss the influence of food and beverage marketing targeting emerging adults, and (iv) illustrate the need for health promotion and intervention efforts that could target young adults through settings such as postsecondary institutions. emerging Adulthood and Collegeaged youth: An overlooked Age for Weight-related behavior Change

Family Meals and Disordered Eating in Adolescents Longitudinal Findings From Project EAT

OBJECTIVE To examine 5-year longitudinal associations between family meal frequency and disordered eating behaviors in adolescents. DESIGN Longitudinal study. SETTING Participants from 31 Minnesota schools completed in-class assessments in 1999 (time 1) and mailed surveys in 2004 (time 2). PARTICIPANTS Adolescents (N=2516) who completed Project EAT (Eating Among Teens)-I (time 1) and -II (time 2) assessments. MAIN OUTCOME MEASURES Time 1 family meal frequency and time 2 disordered eating behaviors, including extreme weight control behaviors (self-induced vomiting and use of laxatives, diet pills, or diuretics), less extreme unhealthy weight control behaviors (eating very little, fasting, using food substitutes, skipping meals, or smoking), binge eating, and chronic dieting. RESULTS Among adolescent girls, time 1 regular family meals (> or = 5 meals/wk) were associated with lower prevalences of time 2 extreme weight control behaviors (odds ratio, 0.71; 95% confidence interval, 0.52-0.97), even after adjusting for sociodemographic characteristics, body mass index, family connectedness, parental encouragement to diet, and extreme weight control behaviors at time 1. Associations with other disordered eating behaviors were also suggestive of a protective effect of family meals in unadjusted analyses but were not statistically significant in adjusted analyses. Among adolescent boys, regular family meals did not predict lower levels of disordered eating behaviors. CONCLUSIONS The high prevalence of disordered eating behaviors among adolescent girls and the protective role of family meals suggest a need for interventions aimed at promoting family meals. Further exploration of predictors of disordered eating behaviors in adolescent boys and the role of family meals is warranted.

Review and special articleFood Insecurity and Weight Status Among U.S. Children and Families: A Review of the Literature

CONTEXT Food insecurity disproportionately affects U.S. demographic groups of children and adult family members at the highest risk for obesity and may lead to weight gain through various pathways. This article reviews research regarding the relationship between food insecurity and weight status, and the potential role of federal food and nutrition assistance programs. EVIDENCE ACQUISITION A search for relevant peer-reviewed research studies among U.S. children and nonelderly adults, published between 2000 and March 2010, identified 42 studies regarding the relationship between food insecurity and weight status. There were 22 studies regarding the potential role of food and nutrition assistance programs. EVIDENCE SYNTHESIS Among children and men, support for an association between food insecurity and weight status has been mixed. Women who experience food insecurity are more likely to be overweight or obese compared to women with adequate household resources for food; however, there is little evidence that food insecurity promotes increased weight gain over time. Long-term participation in the Supplemental Nutrition Assistance Program may increase risk for excess weight gain. CONCLUSIONS Additional research addressing the limitations of current studies is needed to fully understand the observed linkages between food insecurity and risk for obesity. Nevertheless, there is substantial evidence these nutritional problems coexist, and it is critical that future efforts to eliminate hunger consider opportunities to promote healthy food choices and physical activity. Evaluations of policy changes and other intervention strategies are needed to determine the potential for food and nutrition assistance programs to more effectively reduce obesity among participants.

Fast Food Intake: Longitudinal Trends during the Transition to Young Adulthood and Correlates of Intake

PURPOSE Frequent fast food intake is associated with poorer diet quality and greater weight gain. The aims of this study were to describe changes in fast food intake during the transition from middle adolescence to young adulthood, and to identify baseline correlates of this eating behavior in early young adulthood. METHODS Data were drawn from Project EAT, a population-based, longitudinal study in Minnesota. Surveys were completed by 935 females and 751 males in high school classrooms at baseline (1998-1999; mean age = 15.9 years) and by mail at follow-up (2003-2004; mean age = 20.5 years). RESULTS Frequent intake of fast food (> or =3 times/week) was reported by 24% of males and 21% of females during adolescence. At follow-up, in early young adulthood the eating behavior increased among males (33%, p < .001), and there was no further increase among females (23%; p = .16). Baseline snack frequency was positively associated with frequency of fast food intake at follow-up among both genders. Baseline peer support for healthy eating among males and both concern about health and self-efficacy for healthy eating among females were inversely related to follow-up fast food intake. Among females, baseline perceptions of time and taste barriers to healthy eating, lunch frequency, television viewing, and unhealthy food availability at home were also positively associated with follow-up fast food intake. CONCLUSIONS Interventions are needed to address the high prevalence of frequent fast food intake among adolescents and young adults. Health professionals should help young people identify convenient and healthful food choices for meals and snacks consumed away from home.

Parental eating behaviours, home food environment and adolescent intakes of fruits, vegetables and dairy foods: longitudinal findings from Project EAT

OBJECTIVE To examine longitudinal associations of parental report of household food availability and parent intakes of fruits, vegetables and dairy foods with adolescent intakes of the same foods. This study expands upon the limited research of longitudinal studies examining the role of parents and household food availability in adolescent dietary intakes. DESIGN Longitudinal study. Project EAT-II followed an ethnically and socio-economically diverse sample of adolescents from 1999 (time 1) to 2004 (time 2). In addition to the Project EAT survey, adolescents completed the Youth Adolescent Food-Frequency Questionnaire in both time periods, and parents of adolescents completed a telephone survey at time 1. General linear modelling was used to examine the relationship between parent intake and home availability and adolescent intake, adjusting for time 1 adolescent intakes. Associations were examined separately for the high school and young adult cohorts and separately for males and females in combined cohorts. SUBJECTS/SETTING The sample included 509 pairs of parents/guardians and adolescents. RESULTS Vegetables served at dinner significantly predicted adolescent intakes of vegetables for males (P = 0.037), females (P = 0.009), high school (P = 0.033) and young adults (P = 0.05) at 5-year follow-up. Among young adults, serving milk at dinner predicted dairy intake (P = 0.002). Time 1 parental intakes significantly predicted intakes of young adults for fruit (P = 0.044), vegetables (P = 0.041) and dairy foods (P = 0.008). Parental intake predicted intake of dairy for females (P = 0.02). CONCLUSIONS The findings suggest the importance of providing parents of adolescents with knowledge and skills to enhance the home food environment and improve their own eating behaviours.

Does television viewing predict dietary intake five years later in high school students and young adults

BackgroundPrior research has found that television viewing is associated with poor diet quality, though little is known about its long-term impact on diet, particularly during adolescence. This study examined the associations between television viewing behavior with dietary intake five years later.MethodsSurvey data, which included television viewing time and food frequency questionnaires, were analyzed for 564 middle school students (younger cohort) and 1366 high school students (older cohort) who had complete data available at Time 1 (1998–1999) and five years later at Time 2 (mean age at Time 2, 17.2 ± 0.6 and 20.5 ± 0.8 years, respectively). Regression models examined longitudinal associations between Time 1 television viewing behavior and Time 2 dietary intake adjusting for sociodemographic characteristics, Time 1 dietary intake, and Time 2 total daily energy intake.ResultsRespondents were categorized as limited television users (<2 hours/daily), moderately high television viewers (2–5 hours/daily), and heavy television viewers (≥5 hours/daily). Among the younger cohort, Time 1 heavy television viewers reported lower fruit intake and higher sugar-sweetened beverage consumption than the other two groups. Among the older cohort, watching five or more hours of television per day at Time 1, predicted lower intakes of fruits, vegetables, whole grain and calcium-rich foods, and higher intakes of trans fat, fried foods, fast food menu items, snack products, and sugar-sweetened beverages (products commonly advertised on television) five years later.ConclusionTelevision viewing in middle and high school predicted poorer dietary intake five years later. Adolescents are primary targets of advertising for fast food restaurants, snack foods, and sugar-sweetened beverages, which may influence their food choices. Television viewing, especially during high school, may have long-term effects on eating choices and contribute to poor eating habits in young adulthood.

Fruit and Vegetable Intake Correlates During the Transition to Young Adulthood

BACKGROUND During the transition from adolescence to young adulthood, the intake of fruit and vegetables tends to decline, and national survey data indicate that few young adults consume the recommended amounts. This study aimed to identify longitudinal correlates of follow-up fruit and vegetable intake in early young adulthood. METHODS Surveys and food frequency questionnaires were completed by 1495 adolescent participants in high school classrooms at baseline (in 1998-1999; mean age=15.9 years, SD=0.8) and by mail at follow-up (in 2003-2004; mean age=20.4 years, SD=0.8). In 2007, linear regression methods were used to identify baseline factors associated with follow-up fruit and vegetable intake. RESULTS Baseline taste preferences, perceived benefits of healthy eating, fast-food intake, time spent watching television, family-meal frequency, and home food availability were correlates of both fruit and vegetable intake during young adulthood across gender. After adjusting for baseline intake, the only correlate of both fruit and vegetable intake during young adulthood across gender was taste preferences. CONCLUSIONS The findings suggest that nutrition interventions for adolescents should provide opportunities for them to taste more fruit and vegetables, and should address supports for healthy eating both within and outside the home environment.

Weight Control Behaviors and Dietary Intake among Adolescents and Young Adults: Longitudinal Findings from Project EAT

BACKGROUND Cross-sectional research has found that dieting during adolescence and the use of extreme weight control behaviors are related to less healthful dietary patterns; however, little is known regarding longitudinal relationships. OBJECTIVE To describe patterns of weight control behavior over 5 years and examine relationships with nutritional outcomes in adolescents and young adults. DESIGN Population-based, longitudinal study in Minnesota. Youth completed Time 1 surveys in 1998-1999, and Time 2 surveys were completed in 2003-2004. SUBJECTS/SETTING The Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire were completed by 1,242 females and 1,007 males in school classrooms at Time 1 and by mail at Time 2. OUTCOME MEASURES AND STATISTICAL ANALYSES PERFORMED: Generalized linear modeling was used to predict each Time 2 outcome of interest (ie, meal and snack frequencies and dietary intake) across patterns of healthful and unhealthful weight control behavior (ie, never-engaging, stopping, starting, and persisting). RESULTS Approximately 45% of females and 17% of males reported persistent use of unhealthful weight control behaviors at both time points. Persisting to use only healthful weight control behaviors was reported by 10% of females and 15% of males. Among females, persistent use of unhealthful weight control behavior was associated (P<0.05) with measures of poorer dietary intake (eg, lower intakes of calcium and vegetables) and less frequent meals, whereas persistent use of healthful weight control behavior was associated with measures (P<0.05) of better dietary intake (eg, less fast food and fewer sugar-sweetened drinks). Among males, few associations were observed between dietary intake and either unhealthful or healthful weight control behavior. CONCLUSIONS Health professionals should guide youth who have weight concerns by encouraging healthful eating habits to achieve or maintain appropriate weight and nutrition goals.

The protective role of family meals for youth obesity: 10-year longitudinal associations

OBJECTIVE To examine whether having family meals as an adolescent protects against becoming overweight or obese 10 years later as a young adult. STUDY DESIGN Data from Project Eating and Activity in Teens -III, a longitudinal cohort study with emerging young adults, were used. At baseline (1998-1999), adolescents completed surveys in middle or high schools, and at 10-year follow-up (2008-2009) surveys were completed online or via mailed surveys. Young adult participants (n = 2117) were racially/ethnically and socioeconomically diverse (52% minority; 38% low income) between the ages of 19 and 31 years (mean age = 25.3; 55% female). Logistic regression was used to associate weight status at follow-up with family meal frequency 10 years earlier during adolescence, controlling and testing for interactions with demographic characteristics. RESULTS All levels of baseline family meal frequency (ie, 1-2, 3-4, ≥5 family meals/wk) during adolescence were significantly associated with reduced odds of overweight or obesity 10 years later in young adulthood compared with never having family meals as an adolescent. Interactions by race indicated that family meals had a stronger protective effect for obesity in black vs white young adults. CONCLUSIONS Family meals during adolescence were protective against the development of overweight and obesity in young adulthood. Professionals who work with adolescents and parents may want to strategize with them how to successfully carry out at least 1 to 2 family meals per week in order to protect adolescents from overweight or obesity in young adulthood.